guests in our studio. please join us, and you can get more information that sfgov.org. it is a wonderful day, and i'm going to go get a burrito. going to go get a burrito. [music] hello, i am ivette torres and welcome to another edition of the road to recovery . today, we will be talking about our military service members, veterans, and their families; and providing support for their substance use and mental health problems.

joining us in our panel today are: jennifer crane, operation enduring freedom veteran, outreach assistant, give an hour, coatesville, pennsylvania; dr. barbara cohoon, deputy director, government relations, national military family association, washington dc; dr. mike haynie, executive director and founder, institute for veterans and military families, syracuse, ny; a. kathryn power, samsha strategic initiative lead for military families and regional administrator region 1, substance abuse and mental health services administration, u.s. department of health and human services, boston, massachusetts. kathryn, there's approximately 2.3 million active

military men and women and about 22 million vets. um, talk to us a little bit about why military families are important to our national security. well, i think that one of the most important reasons that we are paying attention to the military family is because we know that this particular conflict is taking a major toll on military service members and their families. i think it's mrs. obama who uses the statistic, saying that 1 percent of the people are doing 100 percent of the fighting. and i think that statement really resonates with all of us across the united states who really want to understand and help, um, the military family members who have served in the defense of our country to come back into their communities and to really be fully integrated and fully reintegrated into their communities. and i think that we all carry a sense of ownership and a sense of responsibility about that community.

and no longer are military families isolated. and no longer should people who have served in the military only be either in military communities. we really have to embrace them as a national community: in our neighborhoods, in our schools, and, in that way, i think, we show our respect for the work that they have done. and, in fact, we want to embrace and be joyful about their service. and, at the same time, help them become the civilian members as they leave the military, the civilian members of the community that they can. i think it's all part of our national defense, it's all part of our national security. excellent. barbara, and broaden for us the definition of what a military family is. in the past, we looked at military families as being the spouse of the active duty military service member and their families, but now it's so much more broader. i mean, because we have a lot of our service members, both active duty and reserve component, are single or about 50 percent.

and, so, therefore, we are looking at mom, dad, stepmom, stepdad, siblings that are involved as well. and, um, we also have communities that also are very, um, engaged. i mean, when their service member or their guardsman or reservist goes off to iraq or afghanistan, we have found the communities wanting to be very involved as well as kathryn had mentioned. so, we consider them, too, as far as being part of the broader that, um, takes care of our families. a lot of parents are being more and more engaged. i mean, one of the things that we hear is how engaged they are-especially with our wounded, ill, and injured. so, um, our family or definition of family has really expanded. and traditionally, we thought of even the wife, the husband, the children, and now it really it goes, it's more complex than that for the immediate family of, of the military service member.

correct? oh, definitely, because we have partners: those that are together, um, no, not necessary in marriage but are living together. and 'course, now, with the passage of don't ask and don't tell, we have that particular partner going on as well. and so, they are also embraced as far as being part of the, uh, the family as well. and even the veterans administration, i think, is looking very carefully at their definition of family even now, and trying to determine what is the best way to capture those individuals who are, are in a person's life who have an emotional attachment and who are so important for their support. and, i think, the unique circumstances of the past decade at war, in terms of the nature of the conflicts, has also sort of, really pushed that, that issue to the forefront with regard to military members, um, are often married to other military members. so, when you have, um, multiple deployment, sometimes both parents deployed, um, really the definition of who is

assuming a lot of these family roles is changing. it can be other members of the community, um, very often it's children that are assuming a lot of the parental responsibilities, if you will, um, in the face of both parents being deployed or one parent being deployed. um, so i think that the nature of these conflicts has really pushed the boundaries of how we define what a family, what a military family is. so, jen, let's start talking about, giving those parameters, what happens, what are the dynamics that happens in that military family, and what do we need to begin to look out for? um, it's a very isolating feeling, for not only for the service member but also for the family. and, and, in my case, i'm not only a veteran but my brother is also a veteran. so, i got to be on both ends of the spectrum. and, also i'm married now, and my husband was not with me when i deployed-we were just friends. but, he is actually getting to feel the repercussions of

my deployment even though we weren't together when i was overseas. so, um, the span is huge, you know, it goes not only from the people who you are with and a part of your life then but is the aftermath and the people who are with you years later. so, we not to forget about that as well. um, for me, when i was deployed, you know, the being taken away from the family aspect, and it being another part of my life was, like i said, isolating. very, very isolating-you feel kinda, very lost, but you have your military family to fall back on. so, in some way, it was actually easier for me because i had those people that loved and supported me and that i knew that my life depended on. my family, on the other hand, spent, you know, every minute of every day wondering where i was and what i was doing and if i was ok. so, um, it's extremely stressful during the deployment, but the aftermath of it is probably the hardest part. you mean when the person comes back actually and, and what does a member, kathryn, experience once they come back, could they

have some issues related to post-traumatic stress, depression, traumatic brain injuries, or all of the above? well, i think with the case of the current conflict, and certainly, over the last 10 years in iraq and afghanistan, anyone who has been in theater has experienced, i'm sure, some level of trauma. i mean, i don't think any military member could be deployed, and in that environment, and not experience some level of trauma. and, so, from our perspective, we've begin to take a look at, that's a realistic issue and everyone needs to face that. personally, the service members of course are facing it, but the families and the communities need to be ready to understand what that means. so, the universality of trauma, i think, is a very important part of understanding what this community might have, in terms of their conditions. but, in addition to the fact that they are in trauma, or that they have been exposed to combat, they have also been exposed to other forms of violence or have witnessed

violence in ways that are really not normal. i mean, that it is a very abnormal situation. so, therefore, how each individual adjusts to that, to being in combat, to being in a warrior environment is very unique individually. certainly, the military trains people to be prepared for that. certainly, military service members are tremendously resilient. they have very strong resiliency skills. and i, frankly, that is why they are in the military because they have good resiliency skills. but given the nature of this conflict and, particularly, the nature of multiple deployments, they take their toll. they take their toll emotionally, they take their toll behaviorally, and it is very difficult then to come back into the civilian community. to readjust because there is really now what is known as a new normal. and mike, what does a family need to look for because oftentimes the symptoms that the military service member might feel are not visible to the family or not visible to

individuals who may even be conducting an assessment of their situation. yeah, this is a really complex issue because, i think, not only you know, we talked about experiencing trauma in the context of war, but, i think, an issue that is, that is underappreciated in the context of the challenges facing, um, many of our veterans is this idea of transitioning from a military life to a civilian life. the military is really good at, um, using artifacts, symbols, ceremonies, things like that, to sort of intertwine my individual identity with that of being a military member. "i am a marine," you know, to illustrate the point, um, you know, a young marine who was wounded and then because of his injuries had to transition out of the military.

and in talking to him about that transition, he said, "you know, one of the things that i really struggled with is, while i was in the marine corps, i would introduce myself to people, you know, my name is john, i'm a marine," and he said that "all of a sudden, i realized that this moment in time that i'm not a marine anymore," and he said, "i stopped introducing myself to people because i didn't know what to say. because i didn't know how to define who i was." so, his entire identity... ...was wrapped up in being a marine or being a ranger or whatever it is, and i think that this really is a discontinuous transition from military life to civilian life. and, um, as a consequence of that, that you really do feel, feel, um, isolated, you want to withdraw, um, not so much because you know, you don't want social interaction, but, you're not exactly sure where you fit for a period of time. and i, i think, um, that is a challenge that

we don't talk about enough. and when we come back, i wanna be able to talk to jen because you've had experiences that were quite unique when you returned and we are going to start talking a little bit about substance use and, um, some mental health issues. we'll be right back. [music] samhsa has a strategic initiative specifically focused on military families; the reason for that, is that, at this point in history, we have more people and their families who are either in deployment currently or who are in national guard or reserves or who are veterans than ever before. and we know more and more these days about what that toll is, what that takes, on the individual

and on their families. we know that they struggle with, um, separation, they struggle with constant movement, and they just struggle with extra pressures and, um, because of what happens to people in deployment sometimes, they have post-traumatic stress disorder or they have substance abuse issues or their family members and children struggle with, um, their school work. and lots of issues going on. we need to support those families. they need our help with their behavioral health issues, but frankly they just need our help to support them, um, because they've supported us. one of the key issues associated with the training of veterans' families is that the families need to understand something about the returning veterans experience but also their own experience. that veteran has been away. they've worried, they've been concerned, they've had to deal with some of the day-to-day issues of reality without the father or the mother or the spouse being around and

then when the veteran returns, there is this, shall we say rosy expectation that everything is going to go back to normal right away, and that often does not happen. so, the family needs to be prepared to adjust to the returning veteran's presence, but also to readjust to their own emotional reaction to, to having the veteran back in the household and dealing with some of the tensions that the veteran may be experiencing, but they may be experiencing, also. i like to think that our nation owes an obligation to the veteran, but also our nation owes an obligation to the family members 'cause they both served this nation in times of war and we need to make it clear to the family that we recognize that, that sacrifice that they have made- it has been a major sacrifice. and that that transition back to, normal as it were. put quotes around that word "normal" transition back to

a more harmonious working family relationship may take some time. i felt broken, i needed help for my addiction and depression and help was there. i found support as i rebuilt my life, piece by piece. with the help of my family and recovery support community, i'm rebuilding my life; and through recovery i am whole again. join the voices for recovery. it's worth it. for information on mental and substance abuse disorders, including prevention and treatment referral, call 1-800-662-help. brought to you by the u.s. department of health and human services. [music] i think it is important to point out how many vets are going through substance abuse problems and a lot of that is being due

to the depression, the anxiety, the post-traumatic, the tbi, you know, the loss of limbs, all the things that we've seen and done while we were overseas. it's important for vets and their families to know that they are not alone, that this is more common than we like to admit and that the help is out there. all you have to do is reach out and realize that you are worth it. jen, you previously were alluding to some of the issues that you had upon your return from, from your deployment. do you want to cover some of those for our audience? absolutely. first, i want to go back to what mike was saying, he was talking about, you know, that kind of loss of identity. and that was a huge factor for myself and for my brother and many of the veterans that i've met. as to what we go through when we come home, because all of a sudden you're not a soldier, you are put back in the civilian environment where not only you don't understand where you belong but society doesn't understand where you belong either. so, it, the dynamic is very interesting

when you are watching it. it kinda feels like you are in a bubble all by yourself and you really don't know where you belong. when i came home from overseas, i was very sick. that was the first thing that i lost a ton of weight while i was deployed from dehydration and bad nutrition and everything else-i just really didn't have the time for it quite frankly. and i came home and i had already begun to have nightmares and flashbacks. and i had already isolated myself from my family. i began that process actually while i was deployed. so, when i walked in the door, my family saw me, everybody was happy and crying and i was just very numb. i, i didn't feel anything. i did not want to be there. i wanted to be back overseas-that was where i felt i belonged. and i didn't know-i no longer belonged in my own life back in the united states. so, i very quickly decided that i was going to figure out a way to get rid of the nightmares. i was going to try to figure out where, where i fit in this thing called family. and i started using drugs.

i ended up homeless. i did that on and off for about 3 years. i finally ended up at my local va, where i went into their substance abuse program. i abused, anything that was amphetamine like cocaine, methamphetamines. you name it, i pretty much did it-anything to get rid of kinda what i was feeling. i was also a self-mutilator. it allowed me to feel some kind of emotion, some kind of pain, i guess, it was the inward pain that i couldn't express i was able to do outwardly. and i eventually ended up in a substance abuse program. i then found out that i had chronic post-traumatic stress disorder. i ended up in the program for that and 5 weeks into my program, i left the program and i started using again. i ended up getting involved in solicitation. i was homeless again, living out of my car. and how did you come out of that? it, it was amazing actually, i, right after that period of time,

it was only about 3 months. and i ended up getting arrested, and i said, "i am done." i was jag corps in the military; i wanted no part of being on the wrong side of the law. and i said, "i'm going to get my life together." so, i did. i went through a drug court program. i got counseling. i got on the right meds. i did what i needed to do. and i started talking about it. and started really feeling what i had been through. and i eventually just started to get better with time. very good. barbara, what is there that needs to happen when a family, when a, when a military, ah, service member goes and gets deployed? how should we be working with the families in order to continuously provide support and what type of support need to be there in order for that military member, upon return, to be able to find a better environment to be integrated as mike mentioned earlier? the, the family needs to be prepared right from the get-go, before the deployment actually even happens.

as far as the family getting together, that includes the service member who is forward deploying. irregardless, if it's the husband or a brother as far as getting together to talk about, you know, what's coming up. a lot of the services have programs as far as for families to go to a predeployment briefing. there's a lot of information thats available through the department of defense, as far as on the websites. for families as far as to go to as well, there's military one source, as far as programs. so, families need to get prepared before the deployment happens. get their wills in order, medical power of attorneys, who's going to pay the bills while they're gone, those types of things. if i rent a home or a mortgage. if i'm single, who's going to be taking care of all of that while i'm gone. then once the service member forward deploys, then the families also need support. no only as far as, who the military, but from their communities as well, as kathryn had mentioned before, i mean, we do live out in the communities. in fact, 85 percent, um, of our families actually attend

public schools, and 65 percent actually live out into the communities. and so, where our neighbor, we are your neighbor. um, and so, therefore, that we need support from the communities as well. and if i'm not near a military instillation, so, therefore, i don't have those types of services, then it is even more important to make sure that i am accessing what's available to me, either online or within my local community. and just before they come back, some of the services will actually provide, um, a prereturn, like a reintegration type program, and it is very important for families to go to that as well and engage. and family, as we discussed before, is a fairly broad definition, and so everyone who has a touch point with a service member who's coming back needs to be engaged with those types of program. military one source is a department of defense program. and it is available for parents if they want to get involved. now, once they come back, it's also important for programs to be available at that particular point in time. and the guard and reserve are doing yellow ribbon programs.

and again, families should be involved with that as well. and they are taught signs and symptoms, what to look for if someone's having, um, you know, traumatic brain injury, or showing post-traumatic stress. and where to go as far as for help. and, um, what sort of resources are available. the va even offers a program called coaching into care, which is available as far as for families, so that then reach out to them and they'll help them, guide them, assist them in getting the veteran now into care as far as through the va. so you need, um, a continuum of support for families not only through the department of defense but also as far as through, um, the communities as well. and now the department of veterans affairs is getting very involved in helping families through their vet centers. so, there are a lot of areas which families can go to. but sometimes, they don't know what they don't know. and there is so much out there that they just don't know, where, um, um to go. um, and that was the piece that was missing for me when i came home.

and we have those pieces now, like, my brother, he's done phenomenally because of, we had the information, we had all the programs available to us that weren't available before. what programs did he access, for example? he accessed the yellow ribbon programs that was one i heard, also the, all the va programs. i didn't know about them when i came home, he does, so and he had all that information because he had an educated family who knew what was happening, knew what he was going through, knew what to look for, and where to send him. very good. mike. well, and i think one of the things was just brought up is, is the other side of a very positive coin, meaning that there are lots of programs out there now in a position to help. but one of the things you hear from veterans and military families over and over again is there is so much out there that they become overwhelmed. there are so many programs, there is so much information that it really becomes a challenge, um, trying to identify what the right channel of support is for their particular issue, their particular problem. kathryn in, in terms of substance use disorder and

mental health issues, behavioral health issues, what is important for families to know and, and how can they help the service member? obviously, jen experienced and, and she's not an isolated case. um, well, i think that the most important thing is for people to, as barbara suggested, to get educated and to get smart. and frankly, um, most people whether they are civilian or military are not that well educated about what behavioral health conditions look like. in other words, what are the signs and symptoms of someone who may have a substance abuse or addiction or disorder? what are the signs and symptoms of someone who, who has a mental illness, or who may have a mental health problem? and frankly, that is one of the things that the substance abuse and mental health services administration is pushing is that we really want people to become more knowledgeable about that through programs like mental health first aid, which is a wonderful, um, red cross-like, training program. in about 2 or 3 days, in which you become smart about what

behavioral health conditions look like in humans and how they manifest themselves. a nd where is this program manifested? where is it offered? it's available through the national council of community behavioral health care or you can get training in it across your communities. they can get information about it from samhsa. and so, mental health first aid is the first thing because we are not taught growing up how to pay attention to our emotional health and our emotional well-being. we are taught about what to do about our physical health, a headache, a broken bone, but not about our emotions. so, the first thing is that families, particularly families with military members, i think, need to become more educated about what are those signs and symptoms that barbara referred to. and then, i think there are particular emotional clues, the touch points, um, how they are behaving socially. how are they, are they going back and getting an education, are they looking to, where are they going to work. are, are they being connected with peers? because, a lot of times, the individuals that have behavioral disorders, a substance abuse problem, or a mental health problem will be referred to by peers.

in other words, it will be a friend who will say, "don't you know that you really don't want to hurt yourself" or "what do you mean you are thinking about hurting yourself?" or "are you thinking about doing something that's dangerous and, and putting yourself in harm's way?" it's a friend or a peer that often helps that individual get connected to the supports and services that are needed. and so, just being aware of those signs and symptoms and being educated about, and be willing, to talk to people about suicide. be willing to talk to people. i was just going to bring that point up exactly. i mean, i mean, we are looking at, taking it away from the issue of the military, even the national football league, some of them, some of the members of the national football league, you are seeing incidents of suicide from traumatic brain injury, and this is something that the service men and women suffer constantly. and, and so how does one, um, in a family environment, look out for that particular person?

i mean, they may have been assessed and i go back to it, that mike has mentioned, everyone has mentioned, there are tons of programs that can assess, that can identify, but what does the immediate family need to be very sensitive to in terms of that military member? well, i think jen referred to the isolation. so, i think family members really need to pay attention. and, and be of assistance as possible whenever necessary, to be sure and make sure that people are not isolated. they are not separate. they're not alone. that they have some sort of social support. that they have some activities to do. people want to be reconnected to something. it's that lost [inaudible] military. even though they may be putting everyone in harm's way? that's right, and that is when you have to be able to say to people, "i understand, i'm trying to empathize with why you are disconnecting, but, but because we love you, we want you to be reconnected with us." and when we come back, i want to be able to continue

this topic because i think this is very important that the public understand the dynamic of what is going on. we will be right back. for more information on national recovery month , to find out how to get involved, or to locate an event near you, visit the recovery month website at recoverymonth.gov. every day i seek a positive... ...direction for my life through my accomplishments... ...and now with help... ...and support from my family and others i own... ...i own... ...i own my recovery from addiction and depression. join the voices for recovery. it's worth it. for more information on mental and substance use disorders, including prevention and treatment referral, call 1-800-662-help. brought to you by the u.s. department of health and human services. [music]

they say a service member commits suicide approximately every day, once a day. at maryland's commitment to veterans, we are navigators. our focus is mental health and substance abuse treatment services to insure that veterans and their families are accessing those services to reach out to our program, but we are really here to insure that veterans and their families are accessing the benefits that they are entitled to. we are also, here to, um, connect them with not only federal resources and state resources but also with their communities. i went to church and i was going to make my peace with god. and i had, um, um, a bullet that was sitting home that i was going to use when i got back. i had lost my family and, um, thought i was going crazy,